Commentary: Why Do Smokers Still Smoke?

This October marks the centennial anniversary of America’s “public health enemy number one”: cigarettes. One-hundred years ago, R.J. Reynolds introduced the first modern cigarette, marking the beginning of a new social, economic and health climate in the United States. As smoking evolved from a fashionable accessory to what we now understand as deadly addiction, at least 43 million Americans still smoke, despite its negative health, social and economic impact.

So why do smokers still smoke?

As the science around smoking continues to grow, we know that there is no silver bullet to quitting. Those of us who have struggled to quit ourselves or who have worked with smokers can tell you that it’s a complex and powerful addiction – from a behavioral, physical and mental perspective. The nicotine in cigarettes changes the chemistry of a smoker’s brain, creating physical dependence. Coupled with the behavioral and social aspects of smoking, it can seem next to impossible for a smoker to quit.

A recent commentary in The New York Times offered a theory as to “Why Smokers Still Smoke.” The authors – two researchers – conducted experiments revolving around a card game to determine how smokers and nonsmokers respond to risk-taking. In a modified version of the “Iowa gambling task,” the researchers asked smokers and nonsmokers to choose the most attractive financial scenario between two options. They found that smokers were more likely than nonsmokers to choose the option that brought short-term financial success, despite the fact that the same option brought long-term financial disaster. Through this data, researchers surmised that smokers are less likely to delay satisfaction and less likely to focus on long-term benefit. Or simply – smokers had less self-control than nonsmokers.

In the commentary, the two researchers themselves say their findings are “admittedly nuanced.” And that “it is not risk taking per se that drives smokers’ risky behavior; it’s a weakness for activities that are profitable most of the time yet hazardous eventually.” They offer that if it is indeed true that smokers have less self-control – that knowledge can then be used to tailor strategies to discourage smoking and help smokers quit.

While the study might have been well-intended, I must raise a cautionary flag. The study was small – just 100 people, both smokers and nonsmokers. If this sounds like hair-splitting, it’s not. Rather, my bigger issue with studies of this nature is that a limited finding can often lead to a wider misperception. Smokers in this country are ostracized enough; as a former smoker who struggled to quit for 25 years – I know firsthand. Weak-willed, selfish, unhealthy, irresponsible – I’ve heard these descriptions and they’re still widely used today to label smokers.

Labeling does not help, nor does oversimplifying a problem that continues to plague more than 43 million Americans today.

While I doubt my two fellow researchers intended to add another label to the vernacular describing smokers, articles of this kind are often boiled down or dissected and the larger points or meanings are lost. Having poor self-control is another new label that could potentially be attached to smokers. I sincerely hope that is not the case. Could it be, that once addicted, smokers reframe their life expectancy and therefore act rationally in valuing the short term over the far less certain “long term” which they believe they may not live to see?

Cheryl G. Healton, DrPH
President and CEO
Legacy®